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Year2 MSK exam2 > SNSA and septic arthritis, part I > Flashcards

SNSA and septic arthritis, part I Flashcards

1
Q

What are the spondlyoarthropathies

A 
AS
psoriatic arthritis
reactive
arthritis with IBD
undifferentiated spondlyarthropathy
acute anterior uveitis
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2
Q

seroneg spondyloarthropathies demographic

A 
male
before age 40
inflammatory of spin and SI
HLA B27 +
RF CCP ANA -
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3
Q

what are the nonvertebral Sx of spondyloartropathies

A 
entehsopathy
asymmetric peripheral arthritis
sausage digits
uveitis
mucocutaneous lesions
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4
Q

HLA MHC and CD cell in spondlyarthropathies

A

B27
MHC1
CD8 CTLs

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5
Q

What bacteria is in stools of AS patients

A

klebsiella

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6
Q

What is targeted in Tx for HLA B 27 diseases

A

Th17 because has main role in inflammation and enthesis

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7
Q

if HLA B27 what else do you need to Dx spondylarthropathy

A

2 features

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8
Q

how do Dx inflammatory back pain

A

morning sitffness > 30 min
pain at night or early morning
improves with exercise

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9
Q

Sacroiliitis on imaging and what Dx spondyloarthropathy

A

plus 1 feature

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10
Q

what are the features of spondylarthropathies!!!

A 
arthritis
enthesitis
uveitis
dactylitis
psoriasis
CD/UC
response to NSAID
FH
HLA B27
elevated CRP
aortic insufficiency
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11
Q

signs of ankylosing spondylitis!!!!

A 
bamboo spine
SI inflammation b/l!!!
increased kyphosis
fatigue
ocular inflammation, uveitis
reduced rib expansion- reduced inhalation
weight loss (systemic sym)
possible atlantoaxial subluxation
pulmonary fibrosis-- upper lobe!!
aortic insufficiency
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12
Q

Essentials for Dx AS

A 
chronic LBP in young adults, insidious onset and worse in mroning
progressive limitation back motion or chest expansion
SI abnormalities
peripheral arthritis
inflammatory eye disease
aortic insufficiency
elevated ESR neg RF CCP
HLA B27 when Dx unclear
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13
Q

what causes limitation of chest expansion in AS

A

upper lobe pulm fibrosis

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14
Q

What is schobers test

A

when measure on back and then bend over and space above iliac crest line does not stretch out, but stays same lenght (loss of curvature)

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15
Q

lab findings for AS

A 
increased ESR
- RF
-anti CCP
mild anemia
HLA B27+
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16
Q

what are imaging for AS

A

MRI gadolinium whole body!!!
may show edema at enthesitis sites before sclerosis megins

CT scans
XR

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17
Q

What is Andersson lesion

A

degeneration of spine from AS

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18
Q

what is shiny corner sign

A

reactive sclerosis!!!

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19
Q

synchondrosis of spine anterior and thick

not in SI joint

A

DISH

diffuse interosseous skeletal hyperostosis

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20
Q

complications AS

A 
uveitis
upper lobe PF
cauda equina fibrosis
aortic regurg
heart block
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21
Q

migratory asymmetric polyarthritis for 3-4 mo
RD CCP negative
unilateral sacroiliitis
dx?

A

psoriatic arthritis

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22
Q

patterns of psoriatic arthritis

A 
unilateral sacroiliitis
oligoarthritis
asymmetrical polyarthritis
DIP
pencil in cup- arthritis mutilans- opera glass
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23
Q

labs in psoriatic arthritis

A 
HLA B27 +
RF CCP neg
UA inc
FE2+ dec!!
Th17 inc IL 17
HIV assoc!!!
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24
Q

essential for Dx psoriatic arthritis

A

psoriasis precedes arthritis
sausage appearnance of fingers and toes
unilateral sacroiliitis
pencil in cup

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25
What bacteria can cause reactive arthritis
chlamydia, ureaplasma, mycoplasma genitalium shigella, salmonella, yersinia enterocolitica and yersinia pseudoTB, campylobacter, clostriduium difficile strep
26
if reactive arthritis from venereal bacterium not responding to Tx
then search for ureaplasma or mycoplasma genitalium
27
What types chalmydia cause GUI
D-K
28
reactive arthritis assoc with
``` enthesopathy- lovers heels inflammatory eye disease circinate balanitis keratoderma blenorrhagicum oral ulcers sacroillitis ```
29
lovers heals
enthesopathy where achilles joins in
30
what is needed for Dx reactive arthritis
large joint oligoarthritis sacroiliitis uveitis, conjunctivitis urethritis
31
IBD arthritis
b/l symmetrical sacroiliitis acts independently of IBD!!!!! peripheral arthritis corresponds to IBD status!!!!
32
hemophiliac cause of effusions usually
blood, hemarthrosis
33
best way to Dx hemarthrosis
MRI | XR can show hemosiderin
34
gram + cocci | group B lancefield Ag
strep agalactiae
35
septic arthritis
monoarthritis | multi joint- RA, group B strep or endocarditis
36
what patients more prone to septic arthritis
anti TNF therapy are twice as susceptible
37
essentials Dx septic arthritis
sudden acute monoarticular large joint prebious joint damage or IV drug use WBC >50,000
38
check for what in suspected septic arthritis in anti TNF therapy or HIV
AFB
39
appearance, viscosity, total WBC and PMN % | of noninflammatory I synovial fluid
clear yellow high viscosity <25% PMN
40
appearance, viscosity, total WBC and PMN % | of inflammatory II synovial fluid
``` opaque low viscosity 2-75,000 >50% PMN positive crystals ```
41
appearance, viscosity, total WBC and PMN % | of purulent type III synovial fluid
opaque green low viscosity >100,000 WBC >75% PMN
42
noninflammatory synovival fluid found in what patients
OA
43
inflammatory synovial fluid in what patients
RA and crystal
44
majority septic arthritis microbes
staph aureus MRSA group B strep pneumococcos ``` gram -: E coli pseudomonas gonorrhea salmonella-- SLE, HIV and SS ```
45
Prosthetic joints have what
biofilm to protect from staph and pseudomonas
46
prosethetic infections when have had prosthetic for >24 mo are caused how
seeding from blood
47
prosthetic infection within 3 mo of gettin prosthetic
staph from surgery
48
``` fever migratory polyarthralgias meningitis pancarditis most likely ```
disseminated gonorrhea
49
common sign of disseminated gonorrhea sequelae
fitz hugh curtis | perihepatitis because of adhesions below liver
50
most common septic arthritis in young adults
gonococcal arthritis
51
Signs disseminated gonococcal infection
``` oligoarthritis tenosynovitis rash on palms and soles fever osteomyelitis possible ```
52
risk factors for gonococcal arthritis disseminated
menstruation, pregnancy C5-9 deficiencies
53
What is needed to Dx disseminated gonococcal infection
urethral, throat, cervical and rectal cultures
54
What is Discitis
spinal septic arthritis
55
what are Sx of spinal septic arthritis
chronic unrelenting back pain, fever, local tenderness thoracolumbar region crosses disc space!!!!! can lead to TB/ Potts
56
Gibbus deformity, paraspinal cold abscess
TB Potts disease
57
vague arthritis
viral
58
common agents for viral arthritis
``` parvo B19 HIV Hep B and C EBV adeno and coxsackie rubella mumps ```
59
how can viral arthritis present
``` migratory wrists hands kneed symmetric rash hep C can look like RA Hep B has urticaria and dec C' ```
60
``` dry eyes and mouth and cough SEVERE joint pain myalgias with weakness palmopustular psoriasis tender mm inc LFT enzymes CPK elevated all auto immune Ab negative b/l pulm infiltrates ```
HIV
61
What immune cell is implicated in Diffuse infiltrative lymphocytosis syndrome DILS
CD8
62
after Tx with HAART for HIV what can happen with inc CD4 count
CD4 can take over and attack | Immune Reconstitution inflammatory syndrome IRIS
63
Sarcoidosis presents how
erythema nodosum hilar adenopathy produces ACE
64
The immune reconsitituion inflammatory syndrome usually relates to what diseases
TB and cryptococcal meningitis
65
What cause erythema nodosum with arthritis
``` Boecks sarcoid bechets UC and crohns Mycoses Pills like BCP Strep ```
66
most common cause erythema nodosum
strep
67
Lofgrens syndrome
sarcoidosis | perihilar lymphadenopathy and erythema nodosum
68
stage II lymes
heart block, bells palsy, migratory arthralgias
69
stage III lymes
oligoarthritis, encephalitis, paresthesias
70
confirmation lyme
western blot

Year2 MSK exam2 (17 decks)

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